Cervical Screening Programme - Coverage Statistics [Management Information]

This publication presents quarterly coverage statistics about the NHS Cervical Screening Programme in England.

Data are presented at clinical commissioning group (CCG), upper tier local authority (LA) and GP practice levels. CCG and LA data are available for the previous 4 years, whereas GP data is available for the past 3 years.

It includes statistics on the number of women eligible and screened in the age groups 25 to 49 and 50 to 64 years old, as well as coverage rates for LAs, CCGs and GP practices.

The 3 dashboards are a presentation of coverage statistics in an interactive online report, including contextual information and links guidance provided by NHS England and Jo’s Cervical Cancer Trust (whom NHS England have collaborated with to produce this resource). There are accompanying open data files in comma separated values (CSV) format which contain all the raw data featured in the dashboards.

The statistics in this report are used to inform policy and to monitor the quality and effectiveness of screening services at local area and GP practice level. Coverage is defined as the percentage of women in a population eligible for screening at a given point in time who were screened adequately within the specified period.

Disruption from the coronavirus pandemic had minimal effect on the data collection during 2020-21 and 2021-22, most screening services continued to submit data returns and data was available from the call and recall IT system.

Due to COVID-19 measures, attendance for screening was less than usual at times during 2020-21 and 2021-22. Coverage data represents a summary of all activity over a longer period of time, this should be considered when interpreting changes in coverage:

• 3.5 years for those aged 25-49 years

• 5.5 years for those aged 50-64 years

Data which includes the COVID-19 period should be interpreted with care.

The statistics are downloaded from information that is routinely collected by the NHS Cancer Screening Programmes (NHSCSP) and is obtained from the Public Health Outcomes Framework (PHOF) and Practice Profile reports produced by the Open Exeter system¹ . These data are updated on a monthly basis, approximately 3 months in arrears.

Due to only minor variations between monthly figures, data are reported quarterly within the dashboard to show greater trends.

Data is collected on all LAs, CCGs and GP practices operating during the 2- year rolling period.

• PHOF – data on coverage² is collected on all LAs

• Practice Profile – data on coverage is collected on CCGs and GP practices operating during the 2-year reporting period

A woman is assigned to a population based on the following definitions:

• GP – the GP practice the woman is registered with

• CCG – based on the postcode of the GP practice the woman is registered with

• LA – based on the woman’s postcode of residence

CCGs and Sub-ICBs

On 1st July 2022, as part of the 2022 Health and Care Act, Clinical Commissioning Groups (CCGs) were abolished and replaced as statutory bodies by Integrated Care Boards (ICBs). As part of a transition phase, the geographical areas of former CCGs have been temporarily maintained, but are now known as Sub Integrated Care board (Sub-ICB) locations. For data provided in the csv files prior to Quarter 1 2022-23, Org names and codes refer to CCG locations. From Quarter 1 2022-23 Org names and codes refer to Sub-ICB locations. Although Sub-ICBs did not apply to the Q1 2022-23 period, the source dataset included those breakdowns so they have been used in the published data.

¹ Prior to Quarter 1 2024-25: NHS Digital ‘Exeter’ system (NHAIS), Cancer Screening Statistics: https://nww.openexeter.nhs.uk/nhsia/index.jsp.  Quarter 1 2024-25 onwards: NHS Cervical Screening Management System (CSMS) accessible here: New NHS Cervical Screening Management System - NHS England Digital.

² See https://fingertips.phe.org.uk/profile/public-health-outcomes-framework and https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency for more information.

NHS England downloads the data from Open Exeter and performs minimal processing using automated processes developed in Python³ as well as spreadsheets (Microsoft Excel). Data are then further processed within the Microsoft Power BI software⁴ application before being made available on the internet.

Most of the figures presented in the report and tables are in the form of simple counts and percentages.

Disclosure control

Disclosure control is applied to the GP Practice and Sub-ICB data. For data from Q2 2023-24 onwards, a version of the Central Suppression Methodology is applied.

Eligible population 0, Screened Population 0

If the number of individuals registered at a practice for one age group is zero, this is reported as zero as there is nothing disclosive about reporting zero individuals in this context.

When 1 or more individuals are registered:

For all cases where at least 1 individual is registered the following steps are applied.

All figures are rounded to the nearest 5. 0-7 are rounded to 5 as reporting zero coverage reveals a fact about all registered individuals (they are not screened).

Coverage is calculated based on the rounded figures, this prevents identification of cases where 100% of individuals are screened.

For the small practices (with a population of 5-15 after rounding): 

Although the rounded counts will be reported for these practices, additional calculations such as coverage, rank and coverage change will not be reported. This is because rounding distorts the coverage values for small practices. e.g. If 0 out of 7 people are screened, this would be rounded to 5 and 5. Reporting coverage is not helpful in these cases (0% reported as 100%).

For practices with a rounded denominator above 15: Coverage, rank and number needed to reach 80% coverage are calculated from the rounded figures.

The steps above are applied to GP Practice and Sub-ICB level.

This replaces the previous method, described here: Throughout the dashboards, any counts of women eligible or screened with values lower than 6 are suppressed. In cases where either number is suppressed, subsequent values for the same organisation, time period and age group are also suppressed (e.g. coverage, rank, etc.). This means when only 1 organisation (GP practice) within a CCG has small numbers (<6), a second GP practice also has data suppressed (even though its counts may be greater than 5). This prevents calculation of the lone GP practice’s values by subtraction from the CCG total. The GP practice with the next smallest eligible population is the practice chosen for secondary suppression.

Definitions:

Coverage

Coverage is defined as the percentage of women in a population who were eligible for screening at a given point in time (e.g. for Q3 2023-24 the time point is 31 December 2023) and who were screened adequately within a specified period. Women are eligible for screening if they are in the screening age range and are not ineligible because their recall has been ceased for clinical reasons (most commonly due to hysterectomy). As the frequency with which women are invited for screening is dependent on age, coverage is calculated differently for different age groups, as follows:

Women aged 25 to 49 years old

Coverage is calculated as the number of women in this age group who have had an adequate screening test within the last 3.5 years as a percentage of the eligible population aged 25 to 49 years old.

   Total number of eligible women aged 25 to 49 with

      an adequate screening test in the last 3½ years

                                                                                                      x100

              Total eligible population aged 25 to 49

Women aged 50 to 64 years old

Coverage is calculated as the number of women in this age group who have had an adequate screening test within the last 5.5 years as a percentage of the eligible population aged 50 to 64 years old.

 Total number of eligible women aged 50 to 64 with

    an adequate screening test in the last 5½ years

                                                                                                    x100

             Total eligible population aged 50 to 64

³ Python is an open source programming language: https://www.python.org/

⁴ Microsoft Power BI, is an analysis and visualisation tool in the suite of BI products offered by Microsoft. More information can be found here on the Power BI website.

The publication page and the introductory page of each of the 3 interactive reports gives details of who the statistics in this publication are aimed at and what they might want to use them for. There are separate dashboards for LA, CCG and GP practice level data. Further guidance is also offered to those who may want to act on the findings in the data.

These are established collections based on complete data (i.e. not a sample).

GP practice name changes

GP practice codes are specific to an organisation and generally do not change. GP practice names do, on occasion, change without a subsequent code change. If a GP practice name changes during the reporting period, only the most recent GP practice name is used throughout this report (i.e. name changes are backdated for the whole reporting period). As GP practice codes are more consistent than GP practice names, they are more suitable to use when comparing different datasets. The GP practice names used in this report are based on those reported on Open Exeter at the time of the data extract.

In the LA and Sub-ICB CSV files, the national totals for eligible and screened may not match the sum of LA totals. The national totals include counts of eligible and screened at all LAs plus ‘Unknown’ LAs.

The national figures reported in the CCG csv file differ from the LA national totals because they are simply the sum all active CCG totals. They do not include totals for ‘unknown’ CCGs.

The data are made available as soon as possible after they have been finalised on Open Exeter and processed by NHS England (around 2 to 3 months after the end of the financial quarter to which the data relate).

All data is published in the interactive online report which is available on the publication webpage:

https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme

The data within the dashboard are also available as a CSV, accessible through the webpage linked above.

As data are published on a 2-year rolling basis, users are advised to download data using the quarterly CSV files if they wish to build a longer time series for their own reporting purposes.

In the dashboard coverage is shown rounded to 1 decimal place.

Maps display coverage based on categories (e.g. less than 70%, 70% to less than 75%). These categories are based on the raw coverage figures.

In some cases the rounded coverage value will not match the coverage category,e.g. 79.97% would be rounded to 80.0%, however, it would be categorised as being in the ‘75% to less than 80%’ category.

The Analytical Services: Population Health, Clinical Audit and Specialist Care team at NHS England maintain awareness of changes that may affect the data through regular meetings and communications with the NHS Cancer Screening Programmes and the Department of Health and Social Care. The dashboard build was originally built as a joint-working initiative between Public Health England, NHS Digital and Jo’s Cervical Cancer Trust, it is now maintained by NHS England.

Local authority regions

Local Authority level data for Q1 2024-25 is unavailable due to a change in the data platform that underpins this publication. Local Authority level data is expected to return in future publications when the new system is available.

Data presented in this quarterly report reflects the PHOF data reported by Open Exeter. This differs from the annual National Statistic report, published by NHS England, which recalculates regional LA data to reflect the areas of responsibility within the cervical screening programme. Therefore, direct comparison of the regional coverage figures, between this quarterly report and the NHS England annual report, are not appropriate for the following regions:

• South East

• South West

• East of England

See Table 1 in the annual report’s quality statement for more details on the changes made in the annual report:

https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-annual/england-2021-2022

Integrated Care Systems (ICSs)

Integrated Care systems (ICSs) were implemented in July 2022, replacing CCGs. Information on ICSs and any associated boundary changes is available at this link:

https://digital.nhs.uk/services/ics-implementation#july-2022-changes

Time series

The CCG level report presents time series data covering the 13 most recent quarters available.

The LA level report presents time series data covering the 13 most recent quarters available.

GP practice level statistics are fixed to the 9 most recent available quarters.

Local and regional comparisons

Across the 3 dashboards, data are presented to allow for both local and regional comparisons where appropriate. For example, LA and CCG data are grouped into regions and can be selected within drop-down menus to permit immediate comparisons.

CCGs are grouped into parent orgs based on the outputs from the source data (Open Exeter). For more information on how these have changed, see the ODS page provides a useful summary:

https://digital.nhs.uk/services/organisation-data-service

The publication is based on information that has been routinely collected by the NHS cervical screening programme for a number of years as part of the operation and performance management of the cervical screening programme.

The standard NHS England security and confidentiality policies have been applied in the production of these statistics. The data are received in aggregate form via the Open Exeter system. The following disclosure controls have been applied to this publication:

See section 1.3 for details of disclosure control.